Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $69.73 / $208.65 / $620.88	Facility		$69.73	$208.65	$620.88
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $7.87 / $11.47 / $40.13	Facility	26	$7.87	$11.47	$40.13
Aetna Facility/Professional Facility Modifier TC Low / Median / High Price $27.60 / $199.19 / $538.73	Facility	TC	$27.60	$199.19	$538.73
Aetna Facility/Professional Professional Modifier Low / Median / High Price $9.17 / $39.22 / $124.00	Professional		$9.17	$39.22	$124.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $7.95 / $13.08 / $43.24	Professional	26	$7.95	$13.08	$43.24
Aetna Facility/Professional Professional Modifier 50 Low / Median / High Price $35.09 / $78.90 / $234.12	Professional	50	$35.09	$78.90	$234.12
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $14.78 / $17.23 / $43.60	Professional	52	$14.78	$17.23	$43.60
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $24.44 / $30.21 / $81.00	Professional	TC	$24.44	$30.21	$81.00
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $31.07 / $51.74 / $73.23	Professional		$31.07	$51.74	$73.23
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.20 / $12.71 / $16.75	Professional	26	$7.20	$12.71	$16.75
Ambetter Facility/Professional Professional Modifier 50 Low / Median / High Price $55.09 / $101.43 / $109.86	Professional	50	$55.09	$101.43	$109.86
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $28.02 / $51.97 / $54.30	Professional	TC	$28.02	$51.97	$54.30
Anthem BCBS Facility/Professional Facility Modifier Low / Median / High Price $34.97 / $64.78 / $103.01	Facility		$34.97	$64.78	$103.01
Anthem BCBS Facility/Professional Professional Modifier Low / Median / High Price $31.20 / $45.89 / $95.81	Professional		$31.20	$45.89	$95.81
Anthem BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $8.36 / $12.30 / $24.11	Professional	26	$8.36	$12.30	$24.11
Anthem BCBS Facility/Professional Professional Modifier 50 Low / Median / High Price $46.00 / $70.31 / $143.71	Professional	50	$46.00	$70.31	$143.71
Anthem BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $23.01 / $35.77 / $73.98	Professional	TC	$23.01	$35.77	$73.98
CareSource Facility/Professional Facility Modifier Low / Median / High Price $11.06 / $38.09 / $55.23	Facility		$11.06	$38.09	$55.23
CareSource Facility/Professional Professional Modifier Low / Median / High Price $9.21 / $33.70 / $60.19	Professional		$9.21	$33.70	$60.19
Cigna Facility/Professional Facility Modifier Low / Median / High Price $46.02 / $70.18 / $136.00	Facility		$46.02	$70.18	$136.00
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.36 / $10.36 / $10.36	Facility	26	$10.36	$10.36	$10.36
Cigna Facility/Professional Facility Modifier TC Low / Median / High Price $35.79 / $35.79 / $35.79	Facility	TC	$35.79	$35.79	$35.79
Cigna Facility/Professional Professional Modifier Low / Median / High Price $32.17 / $56.29 / $99.46	Professional		$32.17	$56.29	$99.46
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.63 / $14.79 / $24.36	Professional	26	$8.63	$14.79	$24.36
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $23.93 / $41.22 / $78.05	Professional	TC	$23.93	$41.22	$78.05
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $43.40 / $69.18 / $145.04	Professional		$43.40	$69.18	$145.04
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $9.65 / $15.38 / $33.20	Professional	26	$9.65	$15.38	$33.20
Kaiser Permanente Facility/Professional Professional Modifier 52 Low / Median / High Price $36.13 / $36.13 / $50.76	Professional	52	$36.13	$36.13	$50.76
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $33.75 / $53.80 / $112.81	Professional	TC	$33.75	$53.80	$112.81
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $10.91 / $40.61 / $70.84	Professional		$10.91	$40.61	$70.84
United Facility/Professional Professional Modifier Low / Median / High Price $33.72 / $46.16 / $84.46	Professional		$33.72	$46.16	$84.46
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.53 / $11.77 / $21.37	Professional	26	$8.53	$11.77	$21.37
United Facility/Professional Professional Modifier TC Low / Median / High Price $24.96 / $34.40 / $65.56	Professional	TC	$24.96	$34.40	$65.56